[99mTc]Tc-PSMA-I&S: Anwendung zur Radioguided Surgery beim rezidivierten Prostatakarzinom

2020 ◽  
Vol 43 (04) ◽  
pp. 309-315
Author(s):  
Tobias Maurer ◽  
Sophie Knipper ◽  
Matthias M. Heck ◽  
Thomas Horn ◽  
Christoph Berliner ◽  
...  
Keyword(s):  
Radioguided Surgery ◽  
Chirurgische Resektion ◽  
Psma Pet ◽  
Zukünftige Entwicklungen

ZusammenfassungDurch die verbesserte Detektionsrate hat sich die PSMA PET in den letzten Jahren zunehmend als bildgebende Standarduntersuchung beim biochemischen Rezidiv eines Prostatakarzinoms etabliert. Im Falle einer limitierten regionären lymphogenen Metastasierung in der PSMA PET rückt gegenwärtig eine chirurgische Resektion im Rahmen einer Salvage-Lymphadenektomie vermehrt in den Fokus. Um hierbei die intraoperative Detektion und somit eine sichere Resektion zu erleichtern, können neue PSMA-gerichtete Radioliganden (z. B. [99 mTc]Tc-PSMA-I&S, imaging&surgery) im Rahmen einer PSMA-radioguided surgery zum Einsatz kommen. Im vorliegenden Beitrag sollen der Ablauf, Ergebnisse sowie zukünftige Entwicklungen der Salvage-Lymphadenektomie mittels PSMA-radioguided surgery vorgestellt werden.

scholarly journals Robotic surgery using a DROP-IN beta probe – feasibility study with 68Ga-PSMA in prostate cancer specimens

2020 ◽  
Author(s):  
Francesco Collamati ◽  
Matthias van Oosterom ◽  
Micol De Simoni ◽  
Riccardo Faccini ◽  
Marta Fischetti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Nodes ◽  
Ex Vivo ◽  
Gamma Probe ◽  
Beta Particle ◽  
Radioguided Surgery ◽  
Robot Assisted ◽  
Tumor Identification ◽  
Psma Pet ◽  
Positive Lymph Nodes

Abstract Background: Recently, a flexible DROP-IN gamma-probe was introduced for robot-assisted radioguided surgery, using traditional low-energy SPECT-isotopes. This study explores the use of a novel DROP-IN beta-particle (DROP-IN b ) detection probe to support the implementation of the large number of PET-tracers available during robot-assisted tumor-receptor-targeted resections. Methods: Following engineering of the DROP-IN b probe, robotic implementation was investigated using surgical specimens. Seven prostate cancer patients with PSMA-PET positive tumors received an intraoperative injection of ~100 MBq 68 Ga-PSMA-11, followed by prostatectomy and extended pelvic lymph node dissection. Results: The probe was able to identify the position of the tumor in the prostate specimens: S/B was > 5 when pathology confirmed that the tumor was located <1 mm below the specimen surface. PSMA-PET positive lymph nodes, as found in two patients, could be identified with the DROP-IN b probe (S/B>3). Conclusions: This ex vivo study underlines the potential to use a DROP-IN b probe for intraoperative tumor identification on the prostate surface and confirmation of PSMA-PET positive lymph nodes.

scholarly journals A DROP-IN Beta Probe for Robot-Assisted 68Ga-PSMA Radioguided Surgery: First Ex Vivo Technology Evaluation Using Prostate Cancer Specimens

2020 ◽  
Author(s):  
Francesco Collamati ◽  
Matthias van OOsterom ◽  
Micol De Simoni ◽  
Riccardo Faccini ◽  
Marta Fischetti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Nodes ◽  
Ex Vivo ◽  
Gamma Probe ◽  
Beta Particle ◽  
Radioguided Surgery ◽  
Robot Assisted ◽  
Psma Pet ◽  
Positive Lymph Nodes

Abstract Background: Recently, a flexible DROP-IN gamma-probe was introduced for robot-assisted radioguided surgery, using traditional low-energy SPECT-isotopes. In parallel, a novel approach to achieve sensitive radioguidance using beta-emitting PET-isotopes has been proposed. Integration of these two concepts would allow to exploit the use of PET-tracers during robot-assisted tumor-receptor-targeted. In this study, we’ve engineered and validated the performance of a novel DROP-IN beta-particle (DROP-INb) detector.Methods: Seven prostate cancer patients with PSMA-PET positive tumors received an additional intraoperative injection of ~70 MBq 68Ga-PSMA-11, followed by robot-assisted prostatectomy and extended pelvic lymph node dissection. The surgical specimens from these procedures were used to validate the performance of our DROP-INb probe prototype, with merged a scintillating detector with a housing optimized for a 12 mm trocar and prograsp instruments. Results: After optimization of the detector and probe housing via Monte Carlo simulations, the resulting DROP-INb probe prototype was tested in a robotic setting. In the ex vivo setting, the probe – positioned by the robot- was able to identify 68Ga-PSMA-11 containing hot-spots in the surgical specimens: signal-to-background (S/B) was > 5 when pathology confirmed that the tumor was located <1 mm below the specimen surface. 68Ga-PSMA-11 containing (and PET positive) lymph nodes, as found in two patients, were also confirmed with the DROP-INb probe (S/B>3). The rotational freedom of the DROP-IN design and the ability to manipulate the probe with the prograsp tool allowed the surgeon to perform autonomous beta tracing. Conclusions: This study demonstrates the feasibility of beta-radioguided surgery in a robotic context by means of a DROP-INb detector. When translated to an in vivo setting in the future, this technique could provide a valuable tool in detecting tumor remnants on the prostate surface and in confirmation of PSMA-PET positive lymph nodes.

Oncological and postoperative outcome of salvage PSMA-radioguided surgery in recurrent prostate cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 270-270
Author(s):  
Thomas Horn ◽  
Isabel Rauscher ◽  
Matthias Eiber ◽  
Hans-Juergen Wester ◽  
Margret Schottelius ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Soft Tissue ◽  
Salvage Surgery ◽  
Biochemical Response ◽  
Radioguided Surgery ◽  
Anatomical Site ◽  
Free Survival ◽  
Soft Tissue Lesions ◽  
Psma Pet

270 Background: Positron-emission tomography (PET) directed against PSMA allows detection of even small metastatic prostate cancer (PC) lesions at low PSA values. In a subset of patients (pts) with recurrent PC salvage surgery might be beneficial. To facilitate removal during salvage surgery, we recently introduced PSMA-targeted radioguided surgery (PSMA-RGS). Methods: 121 consecutive patients with recurrent PC (PSA median: 1.13 ng/ml, range: 0.00 – 13.90 ng/ml; 9 pts under androgen-deprivation therapy) and soft-tissue lesions on 68Ga-PSMA PET after radical prostatectomy underwent 111In- or 99mTc-based PSMA-RGS between April 2014 and May 2017. The rate of complete biochemical response (cBR; PSA < 0.2ng/ml) was determined 6-16 weeks following PSMA-RGS. Biochemical recurrence-free survival (bRFS), PC-specific treatment-free survival and postoperative complications were evaluated. Results: Metastatic soft-tissue lesions from PC metastases could be removed in 120/121 pts (99.2%). One patient died six days postoperatively from a pulmonary embolism, five patients were lost to follow-up. Eleven pts suffered from Clavien grade III complications within 90d from surgery. In 75 out of 115 (65.2%) pts cBR was achieved. cBR was more likely in patients with a preoperative PSA level < 1.13 (76.3% vs. 52.7%) or a single anatomical location of recurrence (71.9% vs. 58.8%). Median bRFS was 5.1 months. At the time of analysis, 15 pts exhibited an ongoing cBR for at least 12 months (range: 12-32 months). A significantly longer bRFS was achieved in pts with a preoperative PSA < 1.13 ng/ml (median 14.9 vs 3.2 months, p = 0.02). In pts with a single compared to multiple location of recurrence we observed a trend towards a longer median bRFS (8.2 months vs. 3.5 months, p = 0.08). After one year of follow-up, 61.6 % of pts did not receive any further PC-directed treatment. Conclusions: PSMA-RGS is a promising tool to enhance intraoperative detection of metastatic lesions in PC with an acceptable complication rate. It leads to a high number of biochemical response with substantial duration in a subset of pts. Our data showed that bRFS was highest in patients with a low preoperative PSA and a single anatomical site of recurrence.

scholarly journals A CT-based radiomics model to detect prostate cancer lymph node metastases in PSMA radioguided surgery patients

2020 ◽  
Vol 47 (13) ◽  
pp. 2968-2977
Author(s):  
Jan C. Peeken ◽  
Mohamed A. Shouman ◽  
Markus Kroenke ◽  
Isabel Rauscher ◽  
Tobias Maurer ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Model Performance ◽  
Local Binary Patterns ◽  
Radioguided Surgery ◽  
Net Benefit ◽  
Psma Pet ◽  
Node Metastases ◽  
Histological Confirmation ◽  
Short Diameter

Abstract Purpose In recurrent prostate carcinoma, determination of the site of recurrence is crucial to guide personalized therapy. In contrast to prostate-specific membrane antigen (PSMA)–positron emission tomography (PET) imaging, computed tomography (CT) has only limited capacity to detect lymph node metastases (LNM). We sought to develop a CT-based radiomic model to predict LNM status using a PSMA radioguided surgery (RGS) cohort with histological confirmation of all suspected lymph nodes (LNs). Methods Eighty patients that received RGS for resection of PSMA PET/CT-positive LNMs were analyzed. Forty-seven patients (87 LNs) that received inhouse imaging were used as training cohort. Thirty-three patients (62 LNs) that received external imaging were used as testing cohort. As gold standard, histological confirmation was available for all LNs. After preprocessing, 156 radiomic features analyzing texture, shape, intensity, and local binary patterns (LBP) were extracted. The least absolute shrinkage and selection operator (radiomic models) and logistic regression (conventional parameters) were used for modeling. Results Texture and shape features were largely correlated to LN volume. A combined radiomic model achieved the best predictive performance with a testing-AUC of 0.95. LBP features showed the highest contribution to model performance. This model significantly outperformed all conventional CT parameters including LN short diameter (AUC 0.84), LN volume (AUC 0.80), and an expert rating (AUC 0.67). In lymph node–specific decision curve analysis, there was a clinical net benefit above LN short diameter. Conclusion The best radiomic model outperformed conventional measures for detection of LNM demonstrating an incremental value of radiomic features.

scholarly journals A DROP-IN beta probe for robot-assisted 68Ga-PSMA radioguided surgery: first ex vivo technology evaluation using prostate cancer specimens

2020 ◽  
Author(s):  
Francesco Collamati ◽  
Matthias van OOsterom ◽  
Micol De Simoni ◽  
Riccardo Faccini ◽  
Marta Fischetti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Nodes ◽  
Ex Vivo ◽  
Gamma Probe ◽  
Beta Particle ◽  
Radioguided Surgery ◽  
Robot Assisted ◽  
Psma Pet ◽  
Positive Lymph Nodes

Abstract Background: Recently, a flexible DROP-IN gamma-probe was introduced for robot-assisted radioguided surgery, using traditional low-energy SPECT-isotopes. In parallel, a novel approach to achieve sensitive radioguidance using beta-emitting PET-isotopes has been proposed. Integration of these two concepts would allow to exploit the use of PET-tracers during robot-assisted tumor-receptor-targeted. In this study, we’ve engineered and validated the performance of a novel DROP-IN beta-particle (DROP-INb) detector.Methods: Seven prostate cancer patients with PSMA-PET positive tumors received an additional intraoperative injection of ~70 MBq 68Ga-PSMA-11, followed by robot-assisted prostatectomy and extended pelvic lymph node dissection. The surgical specimens from these procedures were used to validate the performance of our DROP-INb probe prototype, which merged a scintillating detector with a housing optimized for a 12 mm trocar and prograsp instruments. Results: After optimization of the detector and probe housing via Monte Carlo simulations, the resulting DROP-INb probe prototype was tested in a robotic setting. In the ex vivo setting, the probe – positioned by the robot- was able to identify 68Ga-PSMA-11 containing hot-spots in the surgical specimens: signal-to-background (S/B) was > 5 when pathology confirmed that the tumor was located <1 mm below the specimen surface. 68Ga-PSMA-11 containing (and PET positive) lymph nodes, as found in two patients, were also confirmed with the DROP-INb probe (S/B>3). The rotational freedom of the DROP-IN design and the ability to manipulate the probe with the prograsp tool allowed the surgeon to perform autonomous beta tracing. Conclusions: This study demonstrates the feasibility of beta-radioguided surgery in a robotic context by means of a DROP-INb detector. When translated to an in vivo setting in the future, this technique could provide a valuable tool in detecting tumor remnants on the prostate surface and in confirmation of PSMA-PET positive lymph nodes.

Salvage-Lymphadenektomie des lymphogenen Prostatakarzinomrezidivs

2020 ◽  
Vol 51 (03) ◽  
pp. 258-264
Author(s):  
Lara Franziska Stolzenbach ◽  
Sophie Knipper ◽  
Tobias Maurer
Keyword(s):  
Prospektive Studie ◽  
Sensitivität Und Spezifität ◽  
Radioguided Surgery ◽  
Wird Eine ◽  
Prospektive Studien ◽  
Psma Pet ◽  
Pet Ct

ZusammenfassungDas lymphogene Prostatakarzinomrezidiv kann seit der Einführung funktioneller Bildgebung wie der PSMA PET/CT oft frühzeitig diagnostiziert werden. Aktuelle Studien zur lokalen Behandlung der Lymphknotenmetastasen legen einen positiven Einfluss auf die Prognose bei ausgewählten Patienten nahe. Dennoch ist die Mehrzahl der Studien retrospektiv und aus Mangel an höhergradiger Evidenz gilt die Salvage-Lymphadenektomie (LA) als nicht-leitlinienkonform.Ziel dieser Arbeit ist die kritische Zusammenfassung der aktuellen Datenlage zur Salvage-LA des lymphogenen Prostatakarzinomrezidivs mit dem Fokus auf die bildgebenden Verfahren, die Ausdehnung der LA und den onkologischen Verlauf.Die europäischen Leitlinien empfehlen die Durchführung der Cholin- oder PSMA PET/CT-Bildgebung bei einem Verdacht auf ein Prostatakarzinomrezidiv. Die PSMA-PET/CT ist der Cholin-PET/CT in Sensitivität und Spezifität überlegen und sollte dabei favorisiert werden.Wird eine Salvage-LA dennoch durchgeführt, ist die gängige Praxis eine bilaterale LA – auch bei einem im PSMA-PET/CT nachgewiesenen einseitigen Lymphknotenbefall. Allerdings kann ebenfalls die unilaterale LA in Erwägung gezogen werden. Eine aktuell eingeleitete randomisierte prospektive Studie (ProSTone) soll diese Fragestellung beantworten.Ein neuer vielversprechender chirurgischer Ansatz scheint die PSMA-radioguided surgery zu sein. Sie erleichtert das intraoperative Auffinden von Lymphknotenmetastasen. Langzeitdaten sind aber noch abzuwarten.Insgesamt erreicht die Salvage-LA bei sorgfältig ausgewählten Patienten eine respektable biochemische Ansprechrate. Dennoch sind für die Zukunft prospektive Studien notwendig, um den Stellenwert genauer definieren zu können.

Surgical treatment of malignant melanoma

1999 ◽  
Vol 56 (6) ◽  
pp. 318-323
Author(s):  
Bösch ◽  
Banic
Keyword(s):  
Surgical Treatment ◽  
Malignant Melanoma ◽  
Wird Eine ◽  
Chirurgische Resektion

Die frühe Erkennung und vollständige Exzision ist entscheidend für den Krankheitsverlauf des malignen Melanoms der Haut. Der Sicherheitsabstand bei der chirurgischen Resektion ist heute geringer als vor Jahren und liegt abhängig von der Tumordicke zwischen 1 und 3 cm. Die elektive Lymphadenektomie, das heißt die prophylaktische Entfernung der regionalen Lymphknoten gleichzeitig mit der Nachexzision des Primärtumors, ist umstritten. Sie ist mit einer hohen Komplikationsrate behaftet und bringt nur für eine kleine Subgruppe eine Verbesserung der Überlebensrate. Ein neues Konzept, die Sentinellymphknotenexzision, gewinnt zunehmend an Bedeutung. Durch bestimmte Markierungsmethoden wird derjenige Lymphknoten ermittelt, welcher primär den Lymphabfluß aus dem vom Melanom betroffenen Hautbereich erhält. Dieser Lymphknoten ist repräsentativ für den Metastasenstatus seiner Station. Falls er bei der histologischen Untersuchung eine Metastase zeigt, wird eine vollständige Exzision der regionalen Lymphknotenstation vorgenommen. Diese Methode vermag weitere Hinweise auf die Biologie des Melanoms zu geben und dient als Grundlage für die Wahl von adjuvanten Therapien. Ob sie zu einer Verlängerung der Überlebenszeit führt, ist Gegenstand einer laufenden multizentrischen Studie. Systemische Melanommetastasen haben eine schlechte Prognose. Die chirurgische Resektion von solitären Fernmetastasen hat ihre Bedeutung in der palliativen Behandlung des Melanoms, in Kombination mit adjuvanten Therapien.

Die Behandlung des akuten Koronarsyndroms heute und in Zukunft

2009 ◽  
Vol 66 (4) ◽  
pp. 309-316
Author(s):  
Paul Erne ◽  
Roberto Corti ◽  
Dragana Radovanovic ◽  
Andreas W. Schoenenberger
Keyword(s):  
Zukünftige Entwicklungen

In diesem Artikel werden die entscheidenden Schritte zur Diagnose des akuten Koronarsyndroms besprochen. Die mit der Diagnosestellung einhergehende Risikostratifizierung wird erklärt, und die sich aus der Risikostratifizierung ergebenden therapeutischen Schritte werden dargelegt. Aspekte der Qualitätskontrolle werden anhand des AMIS Plus Registers erläutert. Mögliche zukünftige Entwicklungen werden kurz erörtert.

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